Key inquiry: hospital economic management cost control benefits
0 Introduction
At present, in the socialist market economy conditions, the new health care system reform has been launched, in the new program, the establishment of a basic security system, the establishment of a national basic drug system, improve the primary health care service system, promote the pilot reform of public hospitals, promote the basic public **** Health services equalization of these aspects, in which the public hospital reform is not only the difficulty of the entire health care system reform, but also the key to the success or failure of the reform, the goal of the public hospital reform is to "adhere to the public welfare, the abolition of the mechanism of medicines to compensate for medical care; increase government investment, and promote the reform of the compensation mechanism of the public hospitals; to improve the level of management of the public hospitals, and establish a high-quality, high-efficiency, low-consumption, inexpensive service model." Strengthening the economic management of public hospitals is an important aspect of promoting the reform of public hospitals and improving the management of public hospitals.
1 the current public hospital economic management problems
1.1 to the relevant financial laws and regulations to learn to pay insufficient attention to the implementation of poor hospitals on medical and other related aspects of the study and implementation of laws and regulations pay more attention to the study of the relevant financial laws and regulations, but the study of financial laws and regulations to pay insufficient attention to the implementation of financial laws and regulations due to hospitals to carry out poor implementation of financial laws and regulations caused by the illegal matters, in addition to the compensation payment, but also to be fined, will cause the hospital to the hospitals. But also be fined, will cause great economic losses to the hospital.
Hospitals are more prone to violations of economic laws and regulations in the ground million mainly include: ① government centralized bidding and procurement. ② inaccurate calculation of personal income tax sources, omission or underpayment of taxes. ③ capital over-scale investment in excess of the estimated budget. ④ violation of the charging policy overcharging indiscriminate charges.
1.2 The way to achieve income is unreasonable, there are excessive medical, excessive inspection behavior hospital income is composed of three major components, namely, government investment, medical service income and drug income, government investment accounts for only a small portion of the normal operation of the hospital to maintain and safeguard the reasonable remuneration of medical personnel, the vast majority of the medical services to rely on the income and income from medicines to realize the income from medicines and health materials accounted for a large proportion of the income. The government's input only accounts for a small part of the revenue.
When the hospital distribution system and the department or doctor's business income is directly or indirectly linked, it will trigger the doctor's excessive medical behavior; at the same time, it will also lead to hospitals in violation of the price policy of charging behavior, summarized in the following kinds: compared with the charges, self-established project charges, decomposition charges, repeated charges, pay citrus charges, mandatory charges, beyond the government guide price floating proportion of the price set, improve the frequency of service charges. The company's business is to provide a wide range of services to the public.
1.3 did not establish an effective cost management, system, health resource utilization efficiency is low hospital administrators and workers on the importance and significance of cost management is not enough to understand, there is a blind expansion of the scale of the personnel expansion, personnel expansion, personnel costs increase, capital construction and equipment purchase of green does not take into account the cost of efficiency, one-sided pursuit of high, precise, pointed. Departmental collocation of various health materials and supplies control is not strict, serious waste. Even if the hospital has implemented cost management and accounting, due to the lack of clear policy guidance and the lack of scientific methods, most hospitals cost accounting is also incomplete cost accounting, is still stuck in the income minus expenditures to calculate the balance to calculate the stage of bonuses, the cost management and accounting of the ultimate purpose is not clear, resulting in the utilization of various health resources is inefficient.
1.4 Fixed assets and various materials management level is not high at present, some hospitals are prepared for the registration of assets, the use of incomplete records; the purchase, acceptance of donations and scrapping of equipment does not fulfill the accounting procedures, resulting in discrepancies between the accounts; some equipment, facilities, long-term idling, affecting the effectiveness of the assets, fixed assets, some of the scrapping, disposal does not comply with the relevant procedures.
The hospital in the material management, there are heavy procurement, light management problems, property and material management department procurement of materials, often to experience management instead of inventory cost management; supplemental property and materials, often to experience management instead of inventory cost management; supplemental property and materials, not in accordance with the procurement plan for procurement, not from the hospital's actual starting point, resulting in a number of non-urgent, non-needed, can not be used in the material is also purchased! The company's inventory is not in accordance with the procurement plan, not from the hospital's actual purchase, resulting in some non-urgent, unneeded and unusable materials are also purchased, thus resulting in a large backlog of inventory, taking up a large amount of liquidity.
1.5 Handling of various economic matters and business internal control capabilities and means to improve the hospital in the organization of income, drug and material purchases and accounting expenditures, equipment purchases, contract management, billing, commercial transactions, settlement of funds and other economic matters and business internal control capabilities and means is relatively low, for example: the main problems in the management of the hospital contract are: ① the establishment of the contract on the amount of money terms, light non-amount terms. ① the conclusion of the contract on the amount of terms, light non-amount terms. ② heavy contract signing, light contract fulfillment. ③ contract text management process is not scientific, the responsibility is not clear; and for example: although the use of computer network technology, but the establishment of the entire system is not perfect, the lack of integrated control, summarize, manage and analyze the ability.
1.6 Lack of systematic and effective evaluation indexes of economic and social benefits Although some hospitals have established some evaluation indexes such as: management cost ratio, gearing ratio, current ratio, per capita medical cost, etc., but they are not comprehensive and have not been put into practice to play their due role.
2 Strengthening the economic management of public hospitals
2.1 Strengthen the study of financial laws and regulations in order to implement and enforce the national financial laws and regulations and policies, safeguard the safety and integrity of state-owned assets, plug management loopholes, hospital management and the majority of staff should seriously study: "Accounting Law", "Budget Law", "Individual Income Tax Act", "Provisional Regulations on Business Tax", "VAT Provisional Regulations", "Contract Law", "Bidding Law", "Price Law", "Bills Law", "Financial Rules for Institutions", "Measures for the Management of State-owned Assets in Institutions", "Hospital Financial System", "Hospital Accounting System and the provisions of the internal control of financial accounting in health care institutions (for trial implementation)", "Medical Services Prices in the Xinjiang Uygur Autonomous Region" and other laws and regulations, to improve the theoretical level of economic management.
2.2 Reasonable organization of the hospital's various revenues of the new health care reform program, although it will gradually increase the financial investment in public hospitals, but the abolition of the 15% mark-up rate of medicines after the pilot, as well as the establishment of a universal health insurance system for the per capita cost of medical care control, which is still a major test of the hospital's financial system and the level of economic management, the hospital must improve the level of economic management. Medical personnel must adhere to the legitimate rights and interests of patients as their own responsibility, reasonable diagnosis and treatment; not to participate in the high charges that harm the interests of patients and excessive medical behavior, hospitals should adjust the entire income structure, try to reduce the proportion of income from drug bottles and health materials in the overall income, and improve the proportion of income from medical and technical services, which can not only reduce the burden of the patient's costs, but also improve the hospital's overall revenue This can not only reduce the burden of patient costs, but also improve the overall income of the hospital, the gold content, reasonable and legal organization of the income.
2.3 Establishment of the whole staff and the whole process of cost control system hospital cost objects according to the economic content and use is divided into medical expenditures, drug expenditures, management costs; in the level of cost accounting can be divided into gully hospital-level cost accounting, departmental cost accounting, project cost accounting, single disease cost accounting, and so on. Medical services have uncertainty, each medical technology and services provided by the gang will be due to the patient's demand for medical services time, choice of mode, application of different degrees, and make the cost of medical services have the same. Even the same disease, for different patients, because of its diagnosis and treatment, the degree of disease can also make the medical cost changes, so the costing and management of medical services has its own flavor and complexity.
The hospital hospital level mainly set up cost accounting center, department, team with part-time accountant, forming a top to bottom, from leadership to staff, from the organ logistics to clinical medical technology, all staff all-round process of participation in the cost accounting and control system, which is the premise of the implementation of the hospital full-cost accounting. Only by strengthening cost accounting and control, accurate prediction beforehand, control during the event, accounting after the event, in order to effectively reduce the cost of medical services. Hospitals should strictly control personnel expenses and departmental consumption, reasonable quotas. According to "more work, more pay, according to the ability to allocate" principle of mobilizing the enthusiasm of the staff; the development of cost consumption quota, such as: the proportion of materials issued by the consumption, office expenses, travel expenses, hospitality, amount of control, and the establishment of the corresponding assessment, rewards and penalties system. Hospitals should establish an incentive assessment system based on the assessment of social benefits, to shift from the past heavy economic benefits of the department to both business indicators, but also the quality of medical care, so that the individual income of employees and departmental income decoupling, so that the majority of medical workers consciously control the controllable costs, reduce the waste of resources, reduce costs, and improve the quality and efficiency.
2.4 Do a good job of comprehensive budget management hospital comprehensive budget includes the following: business income budget, cost budget, research budget, engineering investment budget, financial budget. The hospital's medical income and expenditure behavior is not for profit, the preparation of financial budgets must adhere to the income and expenditure, income and expenditure balance, overall balance, to ensure that the principle of focus. Hospital income and expenditure budget preparation according to the Ministry of Health standardized medical charges and cost expenditure items, according to the relevant business volume, and comprehensive hospital characteristics, benefit-oriented line, the pursuit of scientific, reasonable and true. The dean of the hospital is responsible for the overall budget of the hospital, the section chiefs are responsible for the budget of their respective sections, and the financial department is fully responsible for the hospital's budgeting, the balance of the preliminary budget program, the budget issued and budget adjustments and evaluation.
2.5 Improve the management level of property materials hospital materials are divided into three categories: medical instruments, hospital facilities, logistics materials, the management of these materials collectively referred to as hospital materials management. Hospitals on the management of inventory materials to be good at using modern logistics distribution methods, minimize the reserve room, where the supplier can amount of profit distribution of materials and supplies, hospitals as far as possible not to reserve, as far as possible to achieve zero inventory. In the use of materials to change the heavy acquisition, light management, only the distribution of materials, no tracking assessment after the adoption of the phenomenon of serious loss of materials, so that the departments are clear about the month's income and expenditure, and the results of the accounting and personal and departmental labor compensation allocation linked to reduce the use of the process of unreasonable consumption and waste.
2.6 Strictly follow the expenditure approval procedures under internal control hospitals need to develop and introduce to the staff of the financial income and expenditure approval and auditing system. Clearly all kinds of funds expenditure approval authority, all important matters, the approver should be in accordance with their duties and responsibilities and the corresponding procedures, the expenditure of money to implement the "co-signing" approval. When accepting vouchers for payments and receipts, the financial personnel shall strictly check them in accordance with the approved budget and the relevant system. Any departments and individuals must submit written vouchers for the use of money, and indicate the purpose of the money, the amount, the mode of payment and other content. The payment of larger sums of money, need to be accompanied by a valid economic contract or supporting documents related to this, before the payment of funds for the procedures.
"Medical institutions financial accounting internal control regulations (for trial implementation)" from the point of view of the job set up on the internal control of public hospitals. Hospital internal control management to solve the problem such as two issues; engaged in the business activities of personnel qualification and reasonable delegation of authority. Hospital managers should be different positions, different links and parts, different levels of management personnel, there are different levels of authorization. Hospitals in the handling of various economic operations, must be authorized by the prescribed procedures for approval.
2.7 Strengthen the management of foreign economic contracts hospital contracts are broadly divided into seven categories: capital works contracts, procurement contracts, lease contracts, loan contracts, social paid service contracts, advertising contracts, insurance and warranty contracts. Contract management should be strengthened in the following aspects: ① hospitals should be regularly or irregularly organized to participate in the contract project, negotiation, drafting, countersigning, auditing, signing, fulfillment and other contract management personnel to carry out economic contracts related knowledge, laws and regulations of professional training. On this basis, clear responsibilities, strengthen the assessment mechanism to improve the accountability of contract managers. ② play the role of legal adviser, carefully scrutinize the contract terms. For different types of contracts, the hospital should be from the perspective of legal understanding of the implementation of the relevant provisions of the wording of the hospital to form a hospital format contract or format terms. ③ Strengthen the contract performance of financial monitoring and audit supervision, to achieve the active management of the contract.
2.8 Ensure that the inherent value of assets value-added hospitals important to establish and improve the management system of fixed assets, unified leadership, management, hierarchical responsibility, in accordance with the value of management and physical management principles, the implementation of the regular inventory, so that the account is consistent with the accounts, the accounts are consistent with the assets to ensure the safety and integrity of the assets.
Major medical projects in hospitals must carry out scientific and reasonable financial feasibility analysis, to improve the utilization of medical equipment, so that idle equipment as soon as possible. To do a good job of cost-benefit analysis of the use of medical equipment, adhere to economic accounting, to achieve the unity of economic and social benefits.
2.9 The establishment of effective evaluation indicators of economic and social benefits to establish the unity of economic and social benefits of the evaluation indicators, such as: per capita business income, per capita income, return on assets, value-added rate of state-owned assets, the cost of income rate, medical income, health material cost rate, management cost rate, the cost of the patient per capita indicators. The higher the per capita business income, per capita income, return on assets, value-added rate of state-owned assets and other indicators, the better the economic efficiency, the higher the level of utilization and value-added assets. The lower the cost income rate, medical income health material cost rate, management cost rate, the lower the cost per patient, the lower the cost of realizing business income, the lower the cost of realizing business income and the lower the level of the burden of patient costs; thus reflecting the hospital's better economic and social benefits. Take "high quality, high efficiency, low consumption, inexpensive" sustainable development of public hospitals is the only way to reform.
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